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Case 116090

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Mandible

Referral reason

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1 Files Info

Canaray 116090

1. Osteomyelitis in the anterior mandible

The anterior mandible was partially captured in this scan. The buccal surface of the symphyseal region was not clearly visualized. However, sequestered bone is visible in the lingual aspect of the mandible. A periosteal reaction is present at the lingual mandibular surface. Sclerosis is visible in the surrounding bone. The periodontal ligament spaces of the adjacent teeth are slightly widened. This radiographic appearance cannot definitively distinguish a malignancy from osteomyelitis. However, the presence of sequestra and periosteal bone formation are hallmarks of osteomyelitis. At minimum, osteomyelitis of the anterior mandible is present, and requires surgical intervention.

Axial views of anterior mandible

These axial cross-sectional images demonstrate the large sclerotic sequestra that are present in the lingual aspect of the mandible at the midline. The presence of periosteal bone formation at the lingual mandibular surface is also evident in these images. Note the extension of the osteomyelitis into the periapical regions of the mandibular anterior teeth.

Buccolingual views of anterior mandible

These buccolingual cross-sectional images demonstrate the extensive rarefying osteitis that surrounds the sclerotic sequestra in the anterior mandible, as well as the thick granular periosteal bone at the lingual surface of the mandibular body adjacent to the sequestra.

Coronal views of mandibular midline

These coronal cross-sectional images demonstrate the extensive loss of bone at the mandibular midline, as well as the extension of rarefying osteitis into the periapical regions of the mandibular incisors and canines.

2. Secondarily affected tooth 42

Tooth 42 has been secondarily affected by the osteomyelitis originating in the anterior mandible. Rarefying osteitis is present in the periapical region of the tooth and the periodontal ligament space is widened around the apical half of the root.

3. Secondarily affected tooth 41

The osteomyelitis in the anterior mandible extends into the periapical region of tooth 41, and has secondarily affected the tooth. The periodontal ligament space is widened on the distal surface of the apical half of the root.

4. Normal tooth 31

Tooth 31 appears normal radiographically. The periapical periodontal ligament space is slightly widened, but this is a non-significant incidental finding. The tooth appears normal otherwise.

5. Secondarily affected tooth 32

The osteomyelitis in the anterior mandible has secondarily affected tooth 32. The periapical lamina dura has been lost.

6. Normal tooth 33

Tooth 33 has a normal overall radiographic appearance. The periodontal ligament space is slightly widened around the apical half of the root of the tooth, but this is a non-significant incidental finding.